Provider Demographics
NPI:1194274282
Name:DIVINE HEALTH MASSAGE
Entity type:Organization
Organization Name:DIVINE HEALTH MASSAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-916-5120
Mailing Address - Street 1:1100 NASA PKWY
Mailing Address - Street 2:SUITE 206
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77058-3325
Mailing Address - Country:US
Mailing Address - Phone:281-916-5120
Mailing Address - Fax:281-547-7456
Practice Address - Street 1:1100 NASA PKWY
Practice Address - Street 2:SUITE 206
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-3325
Practice Address - Country:US
Practice Address - Phone:281-916-5120
Practice Address - Fax:281-547-7456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-29
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT106454225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty